The proposed research is a novel application of structural equation models to identify the complex pathways through which cardiovascular disease (CVD) risk factors develop from the prenatal period to young adulthood. This research will make a substantial contribution to the growing field of developmental origins of adult health and disease (DOHaD). The project uses data from an ongoing community-based study of a birth cohort from Cebu, Philippines The Cebu Longitudinal Health and Nutrition Survey (CLHNS) recruited women during pregnancy, and has followed the offspring from birth to young adulthood. This 23 year study provides an unparalleled range of health, nutrition, socioeconomic, and environment data from roughly 2,000 individuals. The project includes the laboratory analysis of stored plasma samples to determine levels of multiple CVD risk factors, including lipid profiles (high &low density lipoprotein cholesterol, triglycerides), markers of inflammation (C-reactive protein, pro-inflammatory cytokines) and markers of glucose/insulin homeostasis (HOMA insulin sensitivity and adiponectin). These markers, in addition to blood pressure, and anthropometric indicators of adiposity will be outcome variables for our statistical models. The centerpiece of the project is the development and estimation of structural equation models that represent the complex pathways through which pre- and postnatal nutrition and nutrition-related factors contribute to the development of CVD risk in young adulthood. Key features of these models are that they will allow for the estimation of (a) persistent direct and indirect effects of prenatal exposures, (b) interactions of pre and postnatal factors, and (c) the effects of postnatal growth trajectories, including age/stage-specific effects (e.g. infancy, childhood, adolescence). The proposed research will make important methodological as well as substantive contributions by using methods that have not heretofore been applied to the DOHaD paradigm and by exploring a wide range of interrelated CVD risk factors. PUBLIC HEALTH RELEVANCE: The proposed research will make important methodological and substantive contributions to our understanding of the developmental origins of cardiovascular disease risk in a cohort of Filipino young adults followed from the prenatal period to adulthood.